Intra-capsular complete tonsillectomy, a modification of surgical technique to eliminate delayed post-operative bleeding

Paediatric tonsillectomy in England: A cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008‐2019)

“…This technique removes only part of the tonsil with the retained tonsillar capsule acting as a biological dressing and forming a physical barrier, avoiding injury to the underlying muscle and blood vessels. Large case series have demonstrated that the intracapsular technique results in less pain and bleeding (with rates as low as 0.4%), and fewer readmissions than the traditional extra‐capsular technique (which removes the whole tonsil) 8,9 . Despite this, systematic reviews have been unable to draw conclusions regarding the safety and efficacy of intracapsular tonsillectomy due to low quality data 10‐12 .…”

“…Large case series have demonstrated that the intracapsular technique results in less pain and bleeding (with rates as low as 0.4%), and fewer readmissions than the traditional extra-capsular technique (which removes the whole tonsil). 8,9 Despite this, systematic reviews have been unable to draw conclusions regarding the safety and efficacy of intracapsular tonsillectomy due to low quality data. [10][11][12] Furthermore, intracapsular coblation was not included in the recent American Practice Guideline due to a lack of data on effectiveness.…”

Intracapsular tonsillectomy versus extracapsular tonsillectomy: a safety comparison

“…As outlined earlier, this has also been described as a class 2 or complete intracapsular tonsillectomy. 3,19 Coblation TM technology uses radiofrequency energy and saline to produce a plasma field at the end of a hand held wand; this divides the molecular bonds within tissues reducing them to low molecular weight gases and water that is then aspirated into the suction port at the end of the device wand. 22 Far less thermal damage is imparted to the surrounding tissues by Coblation TM when compared with other conventional devices used for performing tonsillectomy procedures because it uses relatively low temperatures of 60-70 degrees Celsius.…”

“…Despite tonsillectomy procedures being performed, in their truest form, as early as 1906 and the high frequency at which they are performed worldwide today, considerable controversy remains regarding which technique is best to use for optimum efficacy and lowest morbidity. [1][2][3] Traditional tonsillectomy is defined as a procedure that completely removes the palatine tonsil including its capsule by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. 4 Consequently, the underlying pharyngeal muscles, nerve endings and larger extracapsular blood vessels are left exposed and vulnerable to inflammation, infection and bleeding despite ligation or electrocautery.…”

“…19 Since its recent resurrection, global interest and widespread publications have explored whether intracapsular tonsillectomy could represent the ideal surgical technique we have been searching for. 3,5,10,14,20 Results pertaining to safety and efficacy of intracapsular tonsillectomy have been promising but have left a few areas of uncertainty and concern. Although there is mounting evidence for the use of intracapsular tonsillectomy in the management of sleep-disordered breathing in children, there is still a dearth of information and ongoing debate surrounding its use, specifically in recurrent infections as well as in adults.…”